Provider Demographics
NPI:1679045140
Name:SCHUKERT, ROBERT LEWIS JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:SCHUKERT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46900 MONROE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4828
Mailing Address - Country:US
Mailing Address - Phone:760-863-8707
Mailing Address - Fax:760-863-8777
Practice Address - Street 1:44199 MONROE ST STE B
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3094
Practice Address - Country:US
Practice Address - Phone:760-863-8047
Practice Address - Fax:951-306-3756
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator